Pharmacists in general medical practice: a case study of clinical commissioning groups

Abstract

Pharmacists have been identified to address the increasing workload in United Kingdom (UK) general practice. A pilot has been commissioned by National Health Service England (NHSE) to upskill pharmacists for this purpose. Evaluation is underway and early reports indicate that there have been integration issues. The value of pharmacists working in general practice and the level of training required for the role are not fully understood. The research reported in this thesis was started before the NHSE pilot. It was conducted to understand the background of Clinical Commissioning Group (CCG) practice pharmacists (PPs), and their interactions with stakeholders. The rationale was to provide an insight into their working relationships and to generate recommendations to support the integration of pharmacists into general practice. The project was conducted in four CCGs in the West Midlands in 2014 using an interpretive/collective case study approach incorporating mixed methods for data collection. Quantitative data was collected on the background, employment and activities of PPs. Qualitative data was collected on stakeholders’ views of the CCG PP role from commissioners, general practitioners (GPs), and patients. Different commissioning models for PPs were studied to provide a deeper understanding of PPs’ interactions. The workload problems in general practice subsequently modified the focus of this thesis to determine the value of PPs to general practice, the level of training required and to propose a model for the integration of pharmacists into UK general practice. The thesis study identified some determinants of integration found in previously published studies but also discovered new areas specific to the integration of pharmacists into UK general practice. These areas can be grouped into three elements - the pharmacist’s skills and attributes, practice level facilitation and national level support. They are presented as a unique Model for the Successful Integration of Pharmacists into General Practice Teams.